380. Differences in HIV Screening by Age, Gender, Location, Time of Day, and Diagnosis in a High Prevalence Emergency Department
Session: Poster Abstract Session: HIV Epidemiology: Screening and Testing - Outpatient to Inpatient
Thursday, October 8, 2015
Room: Poster Hall
Posters
  • Newark HIV ED Screening.pdf (551.9 kB)
  • Background: Since 1993, the CDC recommendations for HIV counseling and testing were extended to include persons obtaining health care in the Emergency Department (ED).  Those recommendations were strengthened in 2013 when the USPTF recommended yearly testing for those who receive medical care in settings with a HIV seroprevalence of at least 1%.  Situated in Newark, New Jersey, the University Hospital (UH) ED serves a community with a greater than 2% HIV prevalence and a recent study showed a UH ED HIV seroprevalence of 6.5%, of which 33% were unknown diagnoses. 

    Methods: Electronic records for patients seen in the UH ED from October 1st 2014 to February 28th2015 were obtained.  Information was collected on age, gender, ED diagnosis, triage time, and HIV testing.  Individual patients, visits, and patients who were tested for HIV were electronically identified.  Random sampling of 500 patients was performed to identify those eligible for screening.  Univariate analysis was done to assess the screening characteristics of patients by age, gender, time of day, and diagnosis.

    Results: Only an estimated 9% (1,711/18,983) of patients eligible for screened were screened in the ED. Screening rates among eligible patients by age were as follows: 16% (18-25 yrs), 12% (26-35yrs) and 8% (35-45yrs). Overall 7.7% of eligible males and 10.2% of eligible females were screened.    19.6% (19 – 20.1) of eligible patients in fast track were screened versus 1.7% (1.6 - 1.8) in the main ED. 85% of patients screened were triaged between 6AM and 8PM with 90% of all screening tests done by the HIV counseling testing, and referral service.  Individuals with a diagnosis suggestive of increased risk of HIV infection, i.e. patients with an ED diagnosis of screen for venereal disease, venereal disease contact, and screening for unspecific chlamydial diseases, were screened for HIV 41%, 36%, and 28% of the time respectively. 

    Conclusion:  Despite a high background prevalence of HIV only a small fraction of patients were screened in the ED for HIV. Due to the high prevalence of HIV in our urban cities, ED plays an integral public health role in the early identification and linkage to care of patients with HIV. By evaluating our current screening process we can identify opportunities for improvement in HIV testing and linkage to care.

    Jason Zucker, MD1, Gregory Sugalski, MD2, Shobha Swaminathan, MD1 and David Cennimo, MD3, (1)Internal Medicine, Rutgers New Jersey Medical School, Newark, NJ, (2)Emergency Medicine, Rutgers New Jersey Medical School, Newark, NJ, (3)Internal Medicine and Pediatrics, Rutgers New Jersey Medical School, Newark, NJ

    Disclosures:

    J. Zucker, None

    G. Sugalski, None

    S. Swaminathan, None

    D. Cennimo, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 7th with the exception of research findings presented at the IDWeek press conferences.